October 1995 Bulletin

One of the most important causes of malpractice suits is erosion
of the physician-patient relationship. Sources of the problem
include increasing specialization, more emphasis on procedures
administered by technicians rather than physicians, patient expectations
that have been influenced by the media, heightened awareness by
patients of their right as healthcare consumers, decline of the
physician's public image as a healer, growing governmental involvement
in medicine, and the escalating costs of medical care.

You and your office staff should be aware of the many factors
that contribute to bad physician-patient relations. Being both
conscious of your patients' needs and willing to make the extra
effort to assure their maximum satisfaction are the keys to physician-patient
success. In setting up this phase of a loss-control program, you
should heed the following:

Establish standards (and offer training, if needed) for your office
staff in courtesy and telephone etiquette. Encourage employees
to be sensitive to patient requests, complaints and the need for
privacy. Emphasize that they should give equal attention to difficult
as well as pleasant patients.

Pay careful attention to realistic appointment scheduling, office
hours, the amount of time patients spend waiting, fees and payment
schedules, total time spent with each patient, and emergency backup
when you are not available. A specially prepared "Welcome
to Our Practice" letter or brochure can help communicate
these important details to your patients. It should be straight-forward
and attractive, but need not be expensively produced.

You should be your own worst critic in judging how you relate
to patients. Assessing this "rapport quotient" is difficult,
because it is so subjective, but the elements that go into good
patient rapport are fundamental to all relationships. They include
your capacity to balance a healthy professional detachment with
appropriate expressions of compassion. The ability to listen and
the willingness to sympathetically communicate with your patients
are essential.

You must be confident and professional without being overbearing
in order to gain your patients' trust. You must establish the
relationship on a level that delegates the proper degree of authority
to the physician while preserving the patient's dignity and self-respect.
Patients generally don't sue physicians they like.

The law requires that a physician must attempt to make a reasonable
person understand the nature, purpose, advantages, and risks involved
in consenting to or declining a given treatment or procedure.

Informed consent can be the central issue in a lawsuit. Poor communication
of the risks and alternatives involved in a procedure may become,
in the eyes of a jury, an indication that a physician's responsibility
was performed poorly. Well-presented information about a procedure
adds to a physician's stature in the courtroom. An effective informed
consent should incorporate the following:

Do not guarantee results. Even with a good result, a patient may
be angry if an off-hand promise is not fulfilled.

Be sensitive to patients' anxiety levels. Are they alert and attentive,
or are they distracted and not listening?

Use highly technical medical terms sparingly. Be sure to explain
the procedure in understandable language that takes into consideration
the patient's state of mind and intelligence level.

Be particularly careful with a patient who has difficulty understanding
English. Get a qualified interpreter if there is any doubt that
your patient understands you.

Go slowly and ask occasional questions to determine if the patient
really understands.

Encourage the patient and his or her family to ask questions or
express their anxieties about the procedure or treatment.

Be sure to document the substance of the conversation in the medical
record. Studies have shown that patient recall levels for a discussion
about risks can be very low. You need an informed consent form
that requires a patient's signature. Have your malpractice carrier
review your forms.

It is unfortunate that you have to protect yourself from your
patients, but this is the reality. You understand this when you
practice defensive medicine. Please practice defensive patient
relations. Many times a frivolous malpractice suit is simply a
way for an angry patient to vent. Being accessible to your patients,
particularly if they have complaints, will lessen the likelihood
of ending up in the midst of a frivolous, exhausting and expensive
malpractice suit.

Good, long-term relationships with patients are more satisfying
and less litigious. A good physician-patient relationship is really
your best protection against frivolous malpractice suits.

Tips to prevent malpractice claims

1. Establish a good rapport with your patients and their families.
Patients don't sue physicians
they like.

2. Be accessible to your
patients.

3. Explain the risks involved in treatments or procedures in terms
the patient can understand.

4. Listen to patient complaints personally.

5. Only you should authorize the release of patient records.

6. Don't sign unread reports or charts.

7. Be aware that billing complaints can be a
forewarning of a pending malpractice suit.

8. Call your attorney and malpractice insurance carrier the moment
you suspect a malpractice suit is pending or brewing.

9. Teach your staff polite phrases to use when
dealing with unhappy
patients.

10. Don't let your staff "practice medicine."

11. Understand that you are liable for your staff's actions and
instructions.

Reprinted with permission from How to Manage the Business Called
Private Practice, by Yvonne Mart Fox, practice management
consultant, Beverly Hills, Calif.